Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD) or peripheral artery occlusive disease (PAOD), includes all diseases caused by the obstruction of large arteries in the arms and legs; and it also includes a subset of diseases classified as microvascular diseases resulting from episodal narrowing of the arteries (raynauds), or widening thereof (erythromelalgia) i.e. vascular spasms. PVD can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism, or thrombus formation. PVD causes either acute or chronic ischemia (lack of blood supply), typically of the legs.
Some patients suffering from PVD present to their surgeon with insufficient blood flow in their lower extremities. This disease manifests itself along a spectrum: from discomfort after walking to gangrenous toes and/or feet. Surgical bypass using the saphenous vein is the gold standard of treatment for severe PVD. The in situ method of surgical bypass involves leaving the saphenous vein in its native bed and cutting the one-way check valves (a procedure known as a valvulotomy) which would normally insure venous blood flow towards the heart. Without these valves the surgeon is able to utilize the vein as an arterial conduit, in effect “arterializing” the vein. Valvulotomies are typically performed using valvulotomes.